Main information requests of family members of patients in Intensive Care Units. / Principales demandas informativas de los familiares de pacientes ingresados en Unidades de Cuidados Intensivos.

OBJECTIVE: To compile an inventory of information requests prioritized by the family members, to find out which professionals them consider able to respond these requests, and to explore the differences in perception between family members and professionals. DESIGN: Qualitative analysis of content validation and descriptive cross-sectional study. SCOPE: 41 Spanish ICU. PARTICIPANTS: Relatives, physicians and nurses of critical patients. INTERVENTION: From an initial list of questions extracted from literature review, physicians, nurses, and relatives of critical patients incorporated issues that they considered not included. After analyzing content validity, a new list was obtained, which was again submitted to the participants' assessment to evaluate the level of importance that they assigned to each question and which professional they considered appropriate to answer it. RESULTS: most important questions for the relatives: concern about the clinical situation, measures to be taken, prognosis and information. There was a coincidence between relatives and professionals in the priority issues for families. There were significant differences in the importance given to each question: between doctors and relatives (72/82 questions), and between nurses and relatives (66/82 questions) (P<.05). For the relatives, 63% of the questions could be answered by doctors or nurses, 27% preferably by doctors and 10% by nurses. CONCLUSIONS: The most relevant issues for families were prognosis and severity, but also the need for information. Healthcare professionals tend to underestimate the importance of many of the questions that concern families. Relatives feel that most of their concerns can be resolved either by doctors or nurses.

Prevalence of agenesis of frontal sinus in human skulls with metopism.

BACKGROUND: The frontal bone is an anatomical structure of the skull separated by the metopic suture in the childhood. The scientific literature indicates that metopic suture consolidates with closure in the early stages of life. Metopism is the term used to describe a metopic suture that persists up to the adulthood. Persistent metopic suture is associated potentially with the agenesis of the frontal sinus. AIM: To investigate the prevalence of absent frontal sinuses in dry skulls with metopism. MATERIALS AND METHODS: The present study was performed after the approval of the local Committee of Ethics in Research. The sample consisted of dry skulls (n=245), aging between 17 and 50 years old, of the Forensic Medical Institute of Goiânia, Brazil. The skulls underwent anthropological exam in the search for metopism. Radiographic exam was performed in the skulls with metopism to verify the presence or absence of the frontal sinus. The radiographic assessment was performed with a Mobile DaRt Evolution device (Shimadzu, Kyoto, Japan) with protocol set in 64 kV and 16 mA). RESULTS: From the 245 dry skulls, 17 presented metopism. The length of the metopic suture in the skulls, considering the distances between nasio and bregma craniometric landmarks, ranged between 114 mm and 137 mm. Radiographic exams were performed on 16 skulls (one skull was not analysed radiographically because of extensive destruction). Only one skull (6.25%) had the frontal sinus absent. Besides the agenesis, the present study also found four (12.5%) skulls with aplasia and eight (25.0%) hyperplasia of the frontal sinus in dry skulls with metopism. CONCLUSION: The present study found a low prevalence rate of the agenesis of frontal sinuses in dry skulls with metopism.

GEINOFOTE: efficacy and safety of fotemustine in patients with high-grade recurrent gliomas and poor performance status.

PURPOSE: The treatment of recurrent high-grade gliomas (HGG) is controversial. There are different therapeutic schedules but without a clear orientation about which of them should be used in each clinical situation. In addition, when patients suffer a second recurrence or they have poor performance status, they are excluded from clinical trials, although second recurrences and poor performance status are indeed more and more real and common situations in the clinical setting. In this study, we assessed the efficacy and safety of fotemustine (FTM) in HGG [fundamentally, glioblastomas (GB)], independent of time of recurrence or performance status. METHODS/PATIENTS: Retrospective study in HGG patients treated with FTM in second or further line according to standard, the Addeo or any other scheme, starting treatment prior to 30 November 2012. Included patients reflect the regular situation in which the drug is used in terms of comorbidities and analytic situation (hematologic, renal and hepatic functions). Response assessment was performed by MRI and according to the clinical protocols of each center (every 8-12 weeks). Clinical situation and supportive care drugs were evaluated in each medical consultation. Clinical end-points analyzed, among others, were: PFS-6, PFS, OS, response rates, toxicity, quality of life and neurocognitive impact. RESULTS: In terms of activity, an overall response rate of 8 % was observed: partial response 6 % (7 patients) and complete response 2 % (2 patients). The median time to achieve the greater response with FTM was 73 days (4-841 days). Patients treated according to the Addeo schedule had a shorter time to greater response in comparison with other schedules (85.9 vs 114 days), although without statistical significance. There were no significant differences in progression-free survival (PFS) when comparing different FTM schedules or using FTM in first or second recurrence. Median PFS: 3 months. PFS-6: 30.3 %. Overall survival (OS): although without significant differences, a tendency to better survival when using the Addeo schedule versus other schedules was observed (at 6 months, 44.6 vs 34.5 %; at 12 months, 25 vs 23.6 %; at 18 months, 11.5 vs 7.9 %), as well as if earlier use (second vs third line) concerning OS-12 (33.7 vs 18.2 %). Median OS: 5.2 months. Grades 3-4 toxicity was 28 % (31 patients), being neutropenia (4 %) and thrombocytopenia (17 %) the most frequent adverse reactions. From quality of life and neuro-cognitive function perspectives, 11 patients (10 %) and 16 (14 %) improved the Karnofsky Index and neurological impairment, respectively, after FTM treatment. CONCLUSION: This study has shown that FTM is safe and has a comparable activity with other available therapeutic options of use in the treatment of recurrent HGG.

Should we continue temozolomide beyond six cycles in the adjuvant treatment of glioblastoma without an evidence of clinical benefit? A cost analysis based on prescribing patterns in Spain.

PURPOSE: The standard adjuvant treatment for glioblastoma is temozolomide concomitant with radiotherapy, followed by a further six cycles of temozolomide. However, due to the lack of empirical evidence and international consensus regarding the optimal duration of temozolomide treatment, it is often extended to 12 or more cycles, even in the absence of residual disease. No clinical trial has shown clear evidence of clinical benefit of this extended treatment. We have explored the economic impact of this practice in Spain. MATERIALS AND METHODS: Spanish neuro-oncologists completed a questionnaire on the clinical management of glioblastomas in their centers. Based on their responses and on available clinical and demographic data, we estimated the number of patients who receive more than six cycles of temozolomide and calculated the cost of this extended treatment. RESULTS: Temozolomide treatment is continued for more than six cycles by 80.5 % of neuro-oncologists: 44.4 % only if there is residual disease; 27.8 % for 12 cycles even in the absence of residual disease; and 8.3 % until progression. Thus, 292 patients annually will continue treatment beyond six cycles in spite of a lack of clear evidence of clinical benefit. Temozolomide is covered by the National Health Insurance System, and the additional economic burden to society of this extended treatment is nearly 1.5 million euros a year. CONCLUSIONS: The optimal duration of adjuvant temozolomide treatment merits investigation in a clinical trial due to the economic consequences of prolonged treatment without evidence of greater patient benefit.

DNA copy number profiling reveals extensive genomic loss in hereditary BRCA1 and BRCA2 ovarian carcinomas.

BACKGROUND: Few studies have attempted to characterise genomic changes occurring in hereditary epithelial ovarian carcinomas (EOCs) and inconsistent results have been obtained. Given the relevance of DNA copy number alterations in ovarian oncogenesis and growing clinical implications of the BRCA-gene status, we aimed to characterise the genomic profiles of hereditary and sporadic ovarian tumours. METHODS: High-resolution array Comparative Genomic Hybridisation profiling of 53 familial (21 BRCA1, 6 BRCA2 and 26 non-BRCA1/2) and 15 sporadic tumours in combination with supervised and unsupervised analysis was used to define common and/or specific copy number features. RESULTS: Unsupervised hierarchical clustering did not stratify tumours according to their familial or sporadic condition or to their BRCA1/2 mutation status. Common recurrent changes, spanning genes potentially fundamental for ovarian carcinogenesis, regardless of BRCA mutations, and several candidate subtype-specific events were defined. Despite similarities, greater contribution of losses was revealed to be a hallmark of BRCA1 and BRCA2 tumours. CONCLUSION: Somatic alterations occurring in the development of familial EOCs do not differ substantially from the ones occurring in sporadic carcinomas. However, some specific features like extensive genomic loss observed in BRCA1/2 tumours may be of clinical relevance helping to identify BRCA-related patients likely to respond to PARP inhibitors.

Enhancement of confocal microscopy images using Mueller-matrix polarimetry.

A simplified procedure based on Mueller-matrix polarimetry has recently been reported as a method of retinal image improvement in a confocal ophthalmoscope [J. M. Bueno et al., J. Opt. Soc. Am. A 24, 1337 (2007)]. Here, we have applied the technique to imaging static samples providing well-defined reflection properties. The method uses a generator of polarization states in the illumination pathway of a confocal scanning laser system. From the calculated four elements of the Mueller matrix of any sample and instrument combination, the best images defined by different metrics were constructed. For samples with specular, diffuse and mixed reflections, the best-constructed images showed an enhancement in both objective and subjective image quality compared to the original images and those obtained from frame averaging. This technique could improve microscopic imaging in many diverse fields, particularly in biomedical imaging.

Pegfilgrastim and daily granulocyte colony-stimulating factor: patterns of use and neutropenia-related outcomes in cancer patients in Spain--results of the LEARN Study.

Daily granulocyte colony-stimulating factors [(G-CSFs); e.g. filgrastim, lenograstim] are frequently used to reduce the duration of chemotherapy-induced neutropenia (CIN) and the incidence of febrile neutropenia (FN) in cancer patients. A pegylated formulation of filgrastim, pegfilgrastim, which is administered once per cycle, was introduced in Spain in 2003. LEARN was a multi-centre, retrospective, observational study in Spain comparing patterns of use of daily G-CSF and pegfilgrastim, and CIN-related outcomes in adults with non-myeloid malignancies receiving myelosuppressive chemotherapy. Outcome measures were the percentage of patients receiving G-CSF for primary prophylaxis versus secondary prophylaxis/treatment, duration of treatment with G-CSF and incidence of CIN-related complications. Medical records from consecutive patients with documented pegfilgrastim (n = 75) or daily G-CSF (n = 111) use during 2003 were included. The proportion of patients receiving primary or secondary prophylaxis was comparable between the pegfilgrastim (39 and 48% respectively) and daily G-CSF (40 and 48% respectively) groups. However, there was a trend towards less frequent use to treat a neutropenic event such as FN or neutropenia in the pegfilgrastim group (17 versus 30% with daily G-CSF). Chemotherapy-induced neutropenia-related complications were less frequent in patients receiving pegfilgrastim (e.g. FN 11 versus 24% with daily G-CSF). This is the first study to show the potential benefits of pegfilgrastim over daily G-CSF in Spanish clinical practice.

An update on the biology of cancer stem cells in breast cancer

Breast cancer stem cells are defined as cancer cells with self-renewal capacity. These cells represent a small subpopulation endowed with the ability to form new tumours when injected in nude mice. Markers of differentiation have been used to identify these cancer cells. In the case of breast cancer, CD44+/CD24- select a population with stem cell properties. The fact that these cells have self-renewal ability has suggested that this population could be responsible for new tumour formation and cancer relapse. These cells have been shown to be more resistant to chemotherapy and radiotherapy than normal cancer cells. The identification of the molecular druggable alterations responsible for the initiation and maintenance of cancer stem cells is an important goal. In this article we will review all these points with special emphasis on the possible role of new drugs designed to interact with molecular pathways of cancer stem cells (AU)

No disponible

[Pilot study for the inclusion of the portfolio of the family medicine specialist book in training]. / Estudio piloto para la incorporación del portafolio del libro del especialista en medicina de familia en formación.

BACKGROUND: The Spanish Family Medicine National Commission is proposing a new portfolio-type Specialist Training Book (STB). OBJECTIVE: To pilot its contents, structure, and implementation strategies. DESIGN: Cross-sectional, descriptive study. SETTING: A Provincial Family Medicine Teaching Unit. PARTICIPANTS: Twenty-eight tutors and 36 residents. METHODS: For 9 months the participants conducted a training assessment on diverse areas of competence by means of tasks at work. Tutors recorded information on the quality of reflection achieved by residents and the tasks they performed by means of the card model proposed in the STB. Residents filled in an ad hoc survey. A univariate analysis of quantitative data was conducted. RESULTS: Thirty-three surveys were received from residents; 21 tutors handed in 67 evaluation reports (average: 3 per tutor). They dealt with all the areas of competence, particularly those of communication, teaching, and ethics. Tasks most used were clinical sessions, critical incidents and video-recording. Both tutors and residents thought that the new method could be useful for reflecting on clinical practice, understanding their own areas of competence better and for strengthening the tutor-trainee relationship, especially if some suggestions to improve its practical use and reduce time and effort involved were taken into account. CONCLUSIONS: The new STB in its current version or with some modifications is a useful tool for residents' training assessment and is probably accepted well in our ambit.

An infrared study of CO adsorption on silica-supported Ru-Sn catalysts.

CO adsorption on Ru-Sn/SiO(2) catalysts of various Sn/(Ru+Sn) ratios was examined by Diffuse Reflectance Infrared Fourier-Transform Spectroscopy (DRIFTS). The catalysts were prepared by the incipient wetness impregnation method. Catalysts were activated by H(2) reduction at 773 K. CO adsorbed on the catalysts shows spectra whose band frequencies are divided into three groups: (i) High Frequency Region (HFR), containing a band at 2065 cm(-1), (ii) Low Frequency Region 1 (LFR(1)), containing bands at 2040-2015 cm(-1), (iii) Low Frequency Region 2 (LFR(2)), containing bands at 1990 and 1945 cm(-1). The types of adsorbed CO species formed strongly depend on the ratio Sn/(Ru+Sn) in the catalyst, CO pressure and temperature of adsorption. Adsorption of CO on Ru sites in the Ru/SiO(2) catalyst results in LFR(1) bands at 2040-2015 cm(-1), which are independent of the CO pressure but the adsorption complexes are easily destroyed by raising the temperature. The addition of Sn to the catalyst creates new sites for CO adsorption. After adsorption at 298 K, the HFR band at 2065 cm(-1) and LFR(2) bands at 1990-1950 cm(-1) are observed. The relative intensities of these bands increase with increasing Sn-content in the samples. The LFR bands are thermally stable while the HFR band is not. The formation of the corresponding species is favored by increasing the CO pressure. Adsorbed CO species giving LFR(1) bands are assigned to linearly-adsorbed CO on the Ru(0) and/or on the Ru-Sn alloy sites. Adsorbed CO species giving HFR bands are assigned to CO adsorption on Ru(delta+)-O-Sn sites. After low temperature CO adsorption on samples with high Sn-content, only species that show bands at 1990 and 1945 cm(-1) in LFR(2) are observed.

Depolarization effects in the human eye.

We have studied the effects of depolarization in the living human eye by using a spatially resolved Mueller-matrix polarimeter [Opt. Lett. 24 (1999) 64]. Results show that the degree of polarization for the central part of double-pass images is about 0.85 and 0.70 for 2 mm and 5 mm of pupil, respectively. This parameter decreases towards the tails of the image. In the plane of the pupil, the degree of polarization also depends on the analyzed area, and it has been related to the different components of the light coming back from the retina. Values of polarizance suggest that the eye presents a slight polarizing power mainly due to the existence of both circular birefringence and dichroic properties. Polarizance is also larger at the central part of double-pass images (about 0.25 on average) and decreases along the radius. In addition, it has been shown that the major retinal layer where the light is reflected does not depend on the state of polarization of the incident light.

Spatially resolved polarization properties for in vitro corneas.

Spatially resolved polarization properties of in vitro mammalian corneas have been studied by using a Mueller-matrix imaging polarimeter in transmission mode. Sixteen images corresponding to independent combinations of polarization states in the illumination and analyzing pathways are recorded. Spatially resolved Mueller matrices of the samples are calculated from them. Results show that the birefringence of the cornea is almost linear. Although the magnitude of retardation depends on the sample, it is approximately constant at the center and increases towards the periphery. Dichroism and polarizing power are negligible. Maps of the degree of polarization indicate that the cornea basically does not depolarize the totally polarized incident light.

Polarization and retinal image quality estimates in the human eye.

We have previously studied how polarization affects the double-pass estimates of the retinal image quality by using an imaging polarimeter [Opt. Lett. 24, 64 (1999)]. A series of 16 images for independent combinations of polarization states in the polarimeter were recorded to obtain the spatially resolved Mueller matrices of the eye. From these matrices, double-pass images of a point source for light with different combinations of incoming (first-pass) and outcoming (second-pass) polarization states were reconstructed and their corresponding modulation transfer functions were calculated. We found that the retinal image or, alternatively, the ocular aberrations, are nearly independent of the state of polarization of the incident light (in the first pass). This means that a significant improvement in the ocular optics by using a specific type of polarized light could not be achieved. However, quite different estimates of the retinal image quality are obtained for combinations of polarization states in both the first and the second passes in the double-pass apparatus.

Measurement of parameters of polarization in the living human eye using imaging polarimetry.

An imaging polarimeter using liquid-crystal variable retarders (Bueno, J. M., Artal, P. (1999). Double-pass imaging polarimetry in the human eye. Optics Letters, 24, 64-66) has been used to study the parameters of polarization in the living human eye. Retardation introduced by birefringent structures of the eye has been calculated by using a spatially resolved collection of Mueller matrices obtained from series of 16 double-pass retinal images. Results for images with a 2-mm pupil diameter show that although the retardation introduced by the eye in a double-pass varies among individuals, at the central cornea the slow axis is directed along the upper-temporal to lower-nasal line and the ellipticity is close to zero, which indicates the presence of linear birefringence. As pupil size increased, the measured retardation also increased, while ocular birefringence remained linear and azimuthal angle changed without a clear tendency.

[The QUALI Project: a quality study of the structure of the primary care teams (PCT) of Catalonia. The Quality Improvement Commission of the Societat Catalana de Medicina Familiar i Comunitària]. / Proyecto QUALI: un estudio de la calidad de la estructura en los equipos de atención primaria (EAP) de Cataluña. Comissió de Millora de la Qualitat de la Societat Catalana de Medicina Familiar i Comunitària.

OBJECTIVE: To analyse the compliance with the primary health care quality criteria of the Committee for Quality Improvement of the Catalan Society of Family and Community Medicine. DESIGN: Cross-sectional descriptive study. SETTING: Reformed primary care centres (PCC) in Catalonia (186), of which 73 (39.2%) filled out the disk with the results. MEASUREMENTS AND MAIN RESULTS: A total of 202 criteria, divided into five sections (structure and material resources, human resources, work organisation, systems of recording and access, and continuity, confidentiality and participation), were self-evaluated in each PCC. These criteria were defined as basic or optimal and compliance with them was graded from 1 to 4. 72.8% of the criteria were fully complied with. In 7.4% there was partial compliance, and in 19.7% non-compliance. The basic criteria had 74% total compliance, whereas the optimal criteria had 51.9%. The groups with least compliance (sum of the total plus the partial) were records systems (68.6%) and human resources (73.5%). The organisation group had the best compliance (85.5%). By sub-groups, the greatest compliance was found in privacy (93.7%), direct care (89.2%) and recording actions (89.1%). Sub-groups with least compliance were long-term treatments (61.8%), vaccinations (46.4%) and storage (42%). Eight of the 18 criteria not complied with by 50% or more were considered responsibility of the team. There was 37.8% total compliance and 24% partial in the criteria referring to the specific training of primary care professionals. Up to 80% non-compliance was found in quality of long-term prescription records, vaccinations and storage. CONCLUSIONS: The high level of compliance in the sections which depend most on professionals should be noted (accessibility-continuity and organisation). This study is a first approach towards understanding the quality of the structure of PC in Catalonia, and enables proposals for improvement to be set up.

[Diagnosis of dyslipidemia in primary care: a service to be improved. Results of a multicenter evaluation]. / El diagnóstico de las dislipemias en atención primaria: un servicio a mejorar. Resultados de una evaluación multicéntrica.

OBJECTIVE: The variability of the quality of care in the primary care procedures to diagnose lipaemia was evaluated. DESIGN: Observation, multi-centred and retrospective study. SETTING: Random sample of 10 primary care centres in the Murcia region. PATIENTS AND OTHER PARTICIPANTS: Patients over 19 with lipaemia detected over the previous twelve months in the general medical clinics at health centres. 500 cases in all were studied (50 per centre). MEASUREMENTS AND MAIN RESULTS: Compliance with criteria of good clinical practice was evaluated. These criteria were formulated by health centre doctors and included: adequate diagnosis, classification into primary or secondary, phenotype, recording of cardiovascular risk factors and assessment of cardiovascular (CV) risk. The differences between the centres studied and the effect of the centre's characteristics (teaching, location, existence of lipaemia programme) and of the patients' (age and gender) were also examined. We found that none of the cases evaluated satisfied the five quality criteria at the same time. Assessment of CV risk and the aetiopathogenic classification were the criteria least complied with (1.5% +/- 1.0). Centres varied considerably. Their characteristics affected the quality of the procedure evaluated, which in all centres had a lot of room for improvement. CONCLUSIONS: The quality of the procedures for diagnosing lipaemia can be considerably improved. It varies a lot from centre to centre.

El diagnóstico de las dislipemias en atención primaria: un servicio a mejorar. Resultados de una evaluación multicéntrica / The diagnosis of lipaemia in primary care: an improveable service. Results of a multi-centred evaluation

Objetivo. Se evalúa la variabilidad de la calidad asistencial del proceso diagnóstico de las hiperlipemias en atención primaria de salud. Diseño. Estudio observacional, multicéntrico y retrospectivo. Emplazamiento. Muestra aleatoria de 10 centros de atención primaria de salud de la región de Murcia. Pacientes u otros participantes. Sujetos de más de 19 años con hiperlipemia detectada durante los últimos 12 meses en las consultas de medicina general de los centros de salud. Se estudiaron 500 casos en total (50 por centro). Mediciones y resultados principales.Se evaluó el grado de cumplimiento de criterios de buena práctica clínica (diagnóstico adecuado, clasificación en primaria o secundaria, clasificación fenotípica, registro de factores de riesgo cardiovascular y valoración del riesgo cardiovascular) formulados por médicos de centros de salud, así como las diferencias entre los centros estudiados y la influencia de sus características (docencia, ubicación, existencia de programa de dislipemias) y las del paciente (edad y sexo). Encontramos que ninguno de los casos evaluados cumplía de forma simultánea los 5 criterios de calidad, siendo la valoración del riesgo cardiovascular y la clasificación etiopatogénica los que menos se cumplen (1,5 por ciento ñ 1,0).Hay asimismo una amplia variabilidad entre centros, cuyas características influyen en el nivel de calidad del proceso evaluado, que presenta un amplio margen para la mejora en todos ellos. Conclusiones. La calidad del proceso diagnóstico de las hiperlipemias presenta un amplio margen de mejora y se distribuye de forma eterogénea entre los diferentes centros de salud (AU)

Proyecto QUALI: un estudio de la calidad de la estructura en los equipos de atención primaria (EAP) de Cataluña / QUALI PROJECT: a study of the quality of the structure of primary care teams in catalonia

Objetivo. Analizar el nivel de cumplimiento de los criterios de calidad en atención primaria de salud de la Comissió de Millora de la Qualitat de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC). Diseño. Estudio descriptivo tranversal. Emplazamiento. Centros de Atención Primaria (CAP) reformados de Cataluña (186), de los cuales cumplimentaron el disquete con los resultados 73 (39,2 por ciento). Mediciones y resultados principales. Un total de 202 criterios -distribuidos en 5 apartados (estructura y recursos materiales, recursos humanos, organización del trabajo, sistemas de registro y accesibilidad, continuidad, confidencialidad y participación)- fueron autoevaluados en cada CAP. Estos criterios están definidos como básicos u óptimos y se valora su grado de cumplimiento de 1 a 4. El 72,8 por ciento de los criterios se cumplían totalmente, el cumplimiento parcial fue del 7,4 por ciento y un 19,7 por ciento se incumplían. Los criterios básicos presentaron un cumplimiento total del 74 por ciento, mientras que el de los óptimos fue del 51,9 por ciento. Los grupos con menor cumplimiento (suma del total más el parcial) fueron sistemas de registro (68,6 por ciento) y recursos humanos (73,5 por ciento). El mejor cumplimiento lo presenta el grupo de organización (85,5 por ciento). Por subgrupos el mayor cumplimiento se detecta en intimidad (93,7 por ciento), atención directa (89,2 por ciento) y registro de actividad (89,1 por ciento). Los subgrupos con mayor incumplimiento fueron tratamientos de larga duración (61,8 por ciento), vacunas (46,4 por ciento) y almacén (42 por ciento). De los 18 criterios que se incumplen en la mitad o más, 8 se consideran responsabilidad del equipo. Se observa un cumplimiento total del 37,8 por ciento y parcial en el 24 por ciento de los criterios que hacen referencia a la formación específica de los profesionales de AP. Se han obtenido incumplimientos de hasta el 80 por ciento en cuanto a calidad de registros de prescripción crónica, vacunas y almacén. Conclusiones. Cabe destacar el alto grado de cumplimiento de los apartados que más dependen de los profesionales (accesibilidad-continuidad y organización). Este estudio supone una aproximación al conocimiento de la situación de calidad de la estructura de la AP en Cataluña y permite establecer propuestas de mejora (AU)